HomeMy WebLinkAbout1081A 1082A (5)WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, or o certificate of Workers` Compensation Insurance,
or a certified copy thereof (Sec. 3810, Lab. C.)
Policy Nr0110RK4484CompanyHARTFORD GROUP
Certified copy is hereby furnished.
I-1 Certified copy is filed with the county building. inspec-
tion department.
Date-+I-� Applicant ,..,..�.. �rni
TIFI ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
hundred dollars ($100) or less.)
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws.
Date—Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
'Tption, you should become subject to the Workers'
pensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
license Number 409610 Lic. Class B
ControctorBRAMAT.T?A CALIF Date
I am exempt under Sec. 4�4�_
B.BP.C. for this reason
Date:
Signature
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor' ice
Law for the following reason (Section 7031.5, Business and
Professions Code):
F-1 I, as owner of the property, or my employees with
wages as their sole compensation, will do the work and
the structure is not intended or offered for sale (Section
7044, Business and Professions Code).
ly I I, as owner of the property, am exclusively contracting
w+ with licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
Lender's Name TORONTO DOMINION BANK
41
— Lender's AddresFRANCISCO, CA.
s
I certify that I have read this application and state that the
¢ above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
—upon the above-mentioned property for inspection purpo es.
Signature of Applicant or Agent Date
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
ADDRESS
!R•
BUILDING
ADDRESS 1435 S. VALEVIEW DR.
LOCALITY
PR ENT
BUELSDING
CITY DIAMOND BAR ZIP
NEAREST
CROSS ST.
�{ • a
NO, OF BLDGS.
ASSESSOR
MOVING TEL
( ® rJ 8 0 0
tZE OF LOT NOW ON LOT —
MAP BOOK
PAGE
PARCEL
TRACT 42556 BLOCK 11OT4M 20
us,;o¢t�
NO
O 7, 0 2 —85
OWNER BPAP4ALEA LIMITEDN 1eO�
CLCIAL
ONDITIONS
ADDRESS3151 AIRWAY AVE. SUITE N
DISTRICT
GROUP TYPE FIRE
ye1vE
PROCESSED BY
/Q '
Issuance Fee
CITY GA. ZIP 92626
Total Fee
ARCHITECT OR TEL.
ENGINEER BASSENIAN No. 52— 864
STATISTICAL CLASSIFICATION
CLASS NO. 4 DWELL. UNITSf
APT.
APT. CONDO.
ADDRE5s3990 WESTERLY PL. #170 NEWPORT B
SEWER MAP
CONTRACTORBRAMALEA CALIF. NL. —1001
BK.
PG,
VALIDATION
ADDRESS151 AIRWAY AVE. No. 409610
VALUATION
"c
CITY 2626 SS B
$ / H
SIZE FT 2144 INC,3 ORIIEES 2 MILOIESl CHECK
,
DESCRIPTION OF WORK. 24 GR NEW ®
$
1" j 0 8, 1 R
ADD ❑
DENCE ALTER
E]NEW
FINAL
4 1
CONSTRUCTION REPAIR 1:1
DATE
// (
tl ` d7�e
) -34362
USE OF
EXISTING BLDG, NONE DEMOL ElBy
FINAL
I e
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nrrLPRINT) N �'S 001
0702-85
ADDREsSI15T AIRWAY AVE. N COSTA ME 'A,GA.
PR ENT
BUELSDING
ADDRESS
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MOVING TEL
( ® rJ 8 0 0
CONTRACTOR NO.
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ADDRESS
SET BACK YARD HWY REQ IREDTOTAPIR LISETEL N
WI TH
O 7, 0 2 —85
FRONT
P. L. ,
SIDE
P.L.
P.C. Fee $ • b 2. Permit Fee S77 -M
/Q '
Issuance Fee
Investigation Fee
aJa
Total Fee
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